Provider Demographics
NPI:1003509530
Name:NORMAN, KATHERN JOAN (NP)
Entity type:Individual
Prefix:
First Name:KATHERN
Middle Name:JOAN
Last Name:NORMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5322 SEVEN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:ODIN
Mailing Address - State:IL
Mailing Address - Zip Code:62870-1402
Mailing Address - Country:US
Mailing Address - Phone:618-292-6762
Mailing Address - Fax:
Practice Address - Street 1:1250 W WHITTAKER ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-1900
Practice Address - Country:US
Practice Address - Phone:618-548-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2090274791363L00000X
IL209.0274791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner